老年新型冠状病毒合并真菌感染临床分析

doi:10.3969/j.issn.1003-9198.2023.12.002

摘要/Abstract

摘要： 目的回顾性分析老年新型冠状病毒合并真菌感染病人的临床特点、治疗及转归,并探讨新型冠状病毒合并真菌感染的风险因素。方法收集2022年12月13日至2023年1月31日于南京医科大学附属老年医院住院的新型冠状病毒感染病人的临床资料,筛选出痰培养、肺泡灌洗液培养、血培养、尿培养、粪便培养或胃液培养提示真菌感染的病人,并对是否合并真菌感染2组间性别、年龄、Charlson共病指数(CCI)、临床症状、血常规、肝肾功能、血清白蛋白、FPG、HbA1c、hs-CRP、降钙素原、PaO₂、PaCO₂、氧合指数(PaO₂/FiO₂)、D-二聚体、癌胚抗原(CEA)、甲状腺功能、IL-6、淋巴细胞亚群分析、病原学培养结果、真菌报阳距离入院的天数、治疗及转归等数据进行分析。结果共收集新型冠状病毒感染病人169例,其中合并真菌感染病人21例。合并真菌感染病人的中位住院时间为20.0(15.0,28.5)d,以男性病人为主(占81.0%),中位年龄为89.0(81.5,92.5)岁,中位CCI为6(5,9),新型冠状病毒感染临床分型为危重型病人占52.4%,真菌培养以白色念珠菌、光滑假丝酵母菌为主,最终有6例(28.6%)病人死亡。真菌感染组和非真菌感染组在年龄、住院天数、临床分型、降钙素原、血清白蛋白、BUN、FPG、D-二聚体、CEA、PaO₂/FiO₂、最高呼吸支持方式方面差异存在统计学意义(P均＜0.05)。进一步行Logistic回归分析,发现降钙素原(OR=1.411)、最高呼吸支持方式为有创呼吸机(OR=27.482)是新型冠状病毒合并真菌感染的独立影响因素。结论降钙素原、最高呼吸支持方式为有创呼吸机可能是新型冠状病毒合并真菌感染的独立风险因素,临床医生应对新型冠状病毒合并真菌感染高危人群早筛查、早治疗,为病人康复保驾护航。

关键词: 新型冠状病毒感染, 真菌感染, 共病指数, 降钙素原, 呼吸支持

Abstract: Objective To retrospectively analyze the clinical characteristics, treatment and prognosis of the elderly patients with COVID-19 combined with fungal infection, and to explore the risk factors of COVID-19 combined with fungal infection. Methods The clinical data of the patients with COVID-19 who were hospitalized in the Geriatric Hospital of Nanjing Medical University from December 13, 2022 to January 31, 2023 were collected. The patients with positive fungal results in sputum culture, alveolar lavage fluid culture, blood culture, urine culture, stool culture and gastric juice culture were screened. The data of gender, age, Charlson comorbidity index (CCI), clinical symptoms, complete blood count, liver and kidney function, serum albumin, fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), high-sensitivity C-reactive protein (hs-CRP), procalcitonin, arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), oxygenation index (PaO₂/FiO₂), D-dimer, carcinoembryonic antigen (CEA), thyroid function, interleukin-6 (IL-6), lymphocyte subgroup analysis, pathogenic culture results, days from fungal positive to admission, treatment and prognosis were analyzed. Results A total of 169 patients with COVID-19 were collected, including 21 patients combined with fungal infection. Among the patients with COVID-19 combined with fungal infection, the median length of hospital stay was 20.0 (15.0, 28.5) d, male constituted the majority of 81.0%, the median age was 89.0 (81.5, 92.5) years, and CCI was 6 (5, 9); The main clinical classification of COVID-19 among the patients was critical type (52.4%); The main fungi were Candida albicans and Candida glabrata; Six patients (28.6%) ultimately died. 169 patients with COVID-19 were divided into fungal infection group and non-fungal infection group. There were significant differences in age, hospitalization days, clinical classification, procalcitonin, serum albumin, blood urea nitrogen (BUN), FPG, D-dimer, CEA, PaO₂/FiO₂, and the highest respiratory support mode between the two groups (all P<0.05). Further Logistic regression analysis showed that procalcitonin (OR=1.411) and invasive ventilation as the highest respiratory support mode (OR=27.482) were the independent influencing factors for COVID-19 combined with fungal infection. Conclusions Procalcitonin and invasive ventilation as the highest respiratory support mode may be independent risk factors for COVID-19 combined with fungal infection. Early screening and early treatment should be carried out for the high-risk groups of COVID-19 combined with fungal infection, so as to protect the patients.

Key words: COVID-19, fungal infection, comorbidity index, procalcitonin, respiratory support

中图分类号:

R 512.99

单珊, 陈吉海, 邱梁, 欧阳晓俊. 老年新型冠状病毒合并真菌感染临床分析[J]. 实用老年医学, 2023, 37(12): 1193-1198.

SHAN Shan, CHEN Ji-hai, QIU Liang, OUYANG Xiao-jun. Clinical analysis of COVID-19 combined with fungal infection in the elderly[J]. Practical Geriatrics, 2023, 37(12): 1193-1198.

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